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Background The World Health Organisation (WHO) 2013 diagnostic criteria for gestational diabetes mellitus (GDM) has been criticised due to the limited evidence of benefits on pregnancy outcomes in different populations when switching from previously higher glycemic thresholds to the lower WHO-2013 diagnostic criteria. The aim of this study was to determine whether the switch from previous Swedish (SWE-GDM) to the WHO-2013 GDM criteria in Sweden following risk factor-based screening improves pregnancy outcomes. Methods and findings A stepped wedge cluster randomised trial was performed between January 1 and December 31, 2018 in 11 clusters (17 delivery units) across Sweden, including all pregnancies under care and excluding preexisting diabetes, gastric bypass surgery, or multifetal pregnancies from the analysis. After implementation of uniform clinical and laboratory guidelines, a number of clusters were randomised to intervention (switch to WHO-2013 GDM criteria) each month from February to November 2018. The primary outcome was large for gestational age (LGA, defined as birth weight >90th percentile). Other secondary and prespecified outcomes included maternal and neonatal birth complications. Primary analysis was by modified intention to treat (mITT), excluding 3 clusters that were randomised before study start but were unable to implement the intervention. Prespecified subgroup analysis was undertaken among those discordant for the definition of GDM. Multilevel mixed regression models were used to compare outcome LGA between WHO-2013 and SWE-GDM groups adjusted for clusters, time periods, and potential confounders. Multiple imputation was used for missing potential confounding variables. In the mITT analysis, 47 080 pregnancies were included with 6 882 (14.6%) oral glucose tolerance tests (OGTTs) performed. The GDM prevalence increased from 595/22 797 (2.6%) to 1 591/24 283 (6.6%) after the intervention. In the mITT population, the switch was associated with no change in primary outcome LGA (2 790/24 209 (11.5%) versus 2 584/22 707 (11.4%)) producing an adjusted risk ratio (aRR) of 0.97 (95% confidence interval 0.91 to 1.02, p = 0.26). In the subgroup, the prevalence of LGA was 273/956 (28.8%) before and 278/1 239 (22.5%) after the switch, aRR 0.87 (95% CI 0.75 to 1.01, p = 0.076). No serious events were reported. Potential limitations of this trial are mainly due to the trial design, including failure to adhere to guidelines within and between the clusters and influences of unidentified temporal variations. Conclusions In this study, implementing the WHO-2013 criteria in Sweden with risk factor-based screening did not significantly reduce LGA prevalence defined as birth weight >90th percentile, in the total population, or in the subgroup discordant for the definition of GDM. Future studies are needed to evaluate the effects of treating different glucose thresholds during pregnancy in different populations, with different screening strategies and clinical management guidelines, to optimise women's and children's health in the short and long term. Trial registration The trial is registered with ISRCTN (41918550)., Author(s): Maryam de Brun 1, Anders Magnuson 2, Scott Montgomery 2,3,4, Snehal Patil 2, David Simmons 5,6, Kerstin Berntorp 7, Stefan Jansson 8, Ulla-Britt Wennerholm 9, Anna-Karin Wikström 10, Helen [...]

Video games are commonly of interest in autism, with autistic adolescents playing twice as much as their Typically Developing peers. The aims of this study are to investigate whether motivations to play video games measured using the Gaming Attitudes, Motivations and Experiences Scales and autistic traits using the Autism Spectrum Quotient can predict time spent playing video games. 57 participants were recruited from internet forums and completed an online questionnaire. The preliminary results revealed that only escapism and social motivation predicted time spent playing games. Further investigation revealed interactions between autistic traits and several motivational scales, including escapism, completionism, and customisation. This has consequences for future research into how autistic people use video games to ease their anxieties.

Glass-forming liquids exhibit long-lived, spatially correlated dynamical heterogeneity, in which some nm-scale regions in the fluid relax more slowly than others. In the nanoscale vicinity of an interface, glass-formers also exhibit the emergence of massive interfacial gradients in glass transition temperature Tg and relaxation time τ. Both of these forms of heterogeneity have a major impact on material properties. Nevertheless, their interplay has remained poorly understood. Here, we employ molecular dynamics simulations of polymer thin films in the isoconfigurational ensemble in order to probe how bulk dynamic heterogeneity alters and is altered by the large gradient in dynamics at the surface of a glass-forming liquid. Results indicate that the τ spectrum at the surface is broader than in the bulk despite being shifted to shorter times, and yet it is less spatially correlated. This is distinct from the bulk, where the τ distribution becomes broader and more spatially organized as the mean τ increases. We also find that surface gradients in slow dynamics extend further into the film than those in fast dynamics—a result with implications for how distinct properties are perturbed near an interface. None of these features track locally with changes in the heterogeneity of caging scale, emphasizing the local disconnect between these quantities near interfaces. These results are at odds with conceptions of the surface as reflecting simply a higher "rheological temperature" than the bulk, instead pointing to a complex interplay between bulk dynamic heterogeneity and spatially organized dynamical gradients at interfaces in glass-forming liquids. [ABSTRACT FROM AUTHOR]

: Objective: To assess whether self‐reported use of sun‐protective measures and skin examination have changed between 2001 and 2018 in a rural setting. Methods: Repeat cross‐sectional survey of randomly selected households in four rural Victorian towns. People aged 16 years and older were eligible to participate. Logistic regression was used to identify demographic factors associated with sun‐protective measures and skin examination. Results: Overall, 5,328 participated in 2001–2003 and 2,680 in 2016–2018. Among participants who go out in the sun, the mean number of reported sun‐protective measures (2.6±1.3 vs. 2.6±1.6, p=0.867) and the proportion of participants reporting usually/always using sun protection (65.1% vs. 63.9%, p=0.307) were unchanged between the two surveys. However, an increased proportion of participants reported avoiding the sun when outdoors in the more recent survey (from 18.8% to 34.3%, p Conclusions: Given the small changes in sun protection over time, updated skin cancer campaigns are needed to encourage increased sun‐protective behaviours and skin examinations among rural residents. Implications for public health: Results suggest that updated health promotion campaigns targeted to rural areas are warranted., Skin cancer remains a major public health issue in Australia, which is known as ‘the skin cancer capital of the world’.[sup.1] Australia has some of the highest incidence[sup.2] and mortality [...]

Using angle-resolved X-ray photoelectron spectroscopy, sum-frequency generation vibrational spectroscopy, contact angle measurements, and molecular dynamics simulations, we verify that the glass transition temperature (Tg) of polymer glass is lower near the free surface. However, the experimental Tg-gradients showed a linear variation with depth (z) from the free surface, while the simulated equilibrium Tg-gradients exhibited a double exponential z-dependence. In typical simulations, Tg is determined based on the relaxation time of the system reaching a prescribed threshold value at equilibrium. Conversely, the experiments determined Tg by observing the unfreezing of molecular mobility during heating from a kinetically arrested, nonequilibrium glassy state. To investigate the impact of nonequilibrium effects on the Tg-gradient, we reduced the thermal annealing time in simulations, allowing the system to fall out of equilibrium. We observe a decrease in the relaxation time and the emergence of a modified z-dependence consistent with a linear Tg-gradient near the free surface. We further validate the impact of nonequilibrium effects by studying the dependence of the Tg on the heating/cooling rate for polymer films of varying thickness (h). Our experimental results reveal significant variations in the Tg-heating/cooling rate dependence with h below the bulk Tg, which are also observed in simulation when the simulated system is not equilibrated. We explain our findings by the reduction in mass density within the inner region of the system under nonequilibrium conditions, as observed in simulation, and recent research indicating a decrease in the local Tg of a polymer when placed next to a softer material. [ABSTRACT FROM AUTHOR]

The use of glucose sensors to triage post‐discharge follow‐up was investigated among hospital inpatients with type 2 diabetes. Feasibility, utility and patient satisfaction with this model of care were studied. Feasibility was 36.5%, with 90/198 (45.5%) inpatients discharged with glucose sensors but 9.0% unable to use glucose sensors effectively. Follow‐up plans were altered in 76.3% of the patients able to use the sensor technology. Patient satisfaction was high and was improved on follow‐up after 6 months. [ABSTRACT FROM AUTHOR]

Objective Design Setting Population Methods Main Outcome Measures Results Conclusions To identify factors associated with neonatal respiratory distress (NRD) in early Gestational diabetes mellitus (eGDM).Nested case–control analysis of the TOBOGM trial.Seventeen hospitals: Australia, Sweden, Austria and India.Pregnant women, <20 weeks' gestation, singleton, GDM risk factors.Women with GDM risk factors completed an oral glucose tolerance test (OGTT) before 20 weeks: those with eGDM (WHO‐2013 criteria) were randomised to immediate or deferred GDM treatment. Logistic regression compared pregnancies with/without NRD, and in pregnancies with NRD, those with/without high‐dependency nursery admission for ≤24 h with those admitted for >24 h. Comparisons were adjusted for age, pre‐pregnancy body mass index, ethnicity, smoking, primigravity, education and site. Adjusted odds ratios (95% CI) are reported.NRD definition: ≥4 h of respiratory support (supplemental oxygen or supported ventilation) postpartum. Respiratory distress syndrome (RDS): Supported ventilation and ≥24 h nursery stay.Ninety‐nine (12.5%) of 793 infants had NRD; incidence halved (0.50, 0.31–0.79) if GDM treatment was started early. NRD was associated with Caesarean section (2.31, 1.42–3.76), large for gestational age (LGA) (1.83, 1.09–3.08) and shorter gestation (0.95, 0.93–0.97 per day longer). Among NRD infants, >24 h nursery‐stay was associated with higher OGTT 1‐h glucose (1.38, 1.08–1.76 per mmol/L). Fifteen (2.0%) infants had RDS.Identifying and treating eGDM reduces NRD risk. NRD is more likely with Caesarean section, LGA and shorter gestation. Further studies are needed to understand the mechanisms behind this eGDM complication and any long‐term effects. [ABSTRACT FROM AUTHOR]

Featured Application: Oral health-related general health diseases and conditions refers to medical conditions or diseases that have a connection or impact on both oral health and overall health. (1) Background: A study was undertaken to provide a comprehensive profile of the prevalence and distribution, by selected socio-demographic characteristics, of chronic diseases and health conditions including those that impact the oral health and oral health self-care of independently living older adults in rural areas of the state of Victoria; (2) Methods: The study analyzed data from the Crossroads-II project, with a total of 1407 participants aged 55 years and older. Participants responded to questionnaires about their medical health history, health service use, and socio-demographics. In total, 572 attended a 2-h health screening that included an assessment of prescribed medications; (3) Results: Most participants were female (55.3%), with a mean age of 69.1 (SD = 9.2) years. Participants had a high prevalence of medical conditions; the most common were high blood pressure, arthritis, high lipids, hearing loss, and chronic pain. Almost all participants reported taking medications, with an average of 4.3 medications per person. Among those who attended the health screening, 78.1% were taking medications that could cause xerostomia (dry mouth); (4) Conclusions: This study provides initial information on the prevalence of medical conditions, medication usage, and the potential impact on the oral health of older adults living in rural Victoria. This information would be valuable for healthcare and dental workforce planning, policy development, and improving the overall well-being of this population. [ABSTRACT FROM AUTHOR]